Our sincere thanks to Mary Grealy, Judy Feder, and Stephanie Cohen for their insightful comments at this morning’s breakfast.  And a big shout out to Jennifer Berk, Julie Minevich and Jose Guzman, all of whom tweeted, emailed, and contributed to the success of our first breakfast.  If you weren’t able to be with us, you’ll want to read the summary post by Disruptive Women’s Wendy Grossman: 

Now that Healthcare Reform Legislation has finally passed – what’s going to happen next?

“The law is an outline – now the novel has to be written,” said Stephanie Cohen, Co-founder of Golden & Cohen. “This is changing daily.”

What happened, how it happened, and what will happen now were topics discussed at the first meeting of Disruptive Women’s 2010 breakfast series early this morning. The discussion, entitled: “Health Reform: US Patience (not a typo) Pay the Price,” was sponsored by Amplify Public Affairs’ Disruptive Women in Health Care Blog and its media partner, The Hill.

Mary Grealy, President of the Healthcare Leadership Council said Americans waited and waited for the new legislation (this is where the patience comes in) – like kids waiting for Christmas morning.  But now, we have to open the presents and see what’s inside. Did we get what we wanted? Or did we just get socks?  “We either had one of the greatest achievements or the downfall of the republic,” she said.   

Grealy discussed both the positives and the negatives of the new legislation. Most agree that making health insurance more affordable for millions of uninsured Americans was good. “It really was the right thing to do,” she said.

But, what happens next remains to be seen. What if people wait until they get really sick to get health insurance (since they will no longer be denied coverage).  Will that lead to higher rates? “Will Washington say, ‘Hey, we made a mistake and fix it?’” she asked. Or will they go the predictable route and blame the insurance companies?

Will people rather pay a fine, than pay for coverage? Plus, while more Americans will be eligible for Medicaid – they may not be able to get treatment, since many doctors don’t accept it. Just because the legislation passed, doesn’t mean the work is done. “Congress is really going to have to revisit this,” she said. 

After Mary spoke, Judy Feder, Professor of public policy and former Dean of the Georgetown Public Policy Institute talked about the history and politics of the new legislation.  “I’m beside myself with excitement,” Feder said. “My God, you couldn’t have a more dramatic process – we were up, we were down, we were dead, we were alive…. I am of the camp that calls this a bloody miracle.”  

Healthcare reform has been decades in the making, she said. “It goes all the way back to Teddy Roosevelt.”  “This was too big to fail.”   She spoke about all the roadblocks the bill faced – like losing the 60th vote when Scott Brown (R-Mass.) was elected. “I loved Senator Kennedy – but I am still mad at him,” she said. “He could have held on just a little longer.”

Still, the day of the vote was a “cliff-hanger,” she said – no one knew what would happen. But, “they compromised, rallied the troops, and delivered,” she says. “It shows that Congress can get something done…. If we can pass this legislation – we can do anything.”   

Stephanie Cohen, who recited insurance change after insurance change, told the group that the legislation is still a work in progress. “There are a lot of misunderstandings,” Cohen told Disruptive Women. “The book is being written chapter by chapter. It has to be revised. This is just the beginning.”

There isn’t a solid plan for exactly how everything will be implemented.  “I learned that a lot of this is still up in the air,” said Cara Tenenbaum, Vice President of Policy and External Affairs for the Ovarian Cancer National Alliance. “I don’t know what to tell patients. I don’t think anyone does.”   

Still, the discussion this morning tried to fill in the blanks and explain exactly what happened and what’s next.   “It’s important to be able to distill this information, because much of it remains uncertain at this point,” said Santi KM Bhagat, MD, MPH and President of Physician-Parent Caregivers.  “We don’t yet understand the full implication of the legislation… I don’t think there was time for transparency, it moved so fast. It helps to be able to discuss it together.”
   
The next breakfast meeting, “News: (Hot) Flash: Sex, Drugs & Menopause,” will be April 29, 2010 from 7:30 a.m.-9 a.m. If you are interested in attending, please register here: www.disruptivewomen.net/breakfastseries.  Men are welcome, encouraged even, to attend.  Come on, you know you want to.

My name is Susan Tieh.  I am a first-year student at the Yale School of Management, and I aspire to a career in healthcare.  Before coming to business school, I worked at a global health non-profit.  I’ve since decided to direct my passion for increasing access to healthcare to the domestic realm. 

With the recent, historic passage of healthcare reform legislation, the U.S. healthcare system is experiencing its most significant transformation in the last 40 years.  Understanding reform and how it will affect the various players in the healthcare industry are critical to anyone affected by healthcare in the United States – in other words, it is critical for all Americans.

On April 9 in New Haven, Connecticut, the sixth annual Yale Healthcare Conference will provide a timely forum for understanding and discussing reform.  The conference’s theme is “Re-forming Healthcare: Excelling in a Transforming System.”  We have a number of exciting speakers, including Dr. Robert Galvin, Executive Director of Health Services and Chief Medical Officer at General Electric, and Dr. Gail Wilensky, Economist and Senior Fellow at Project HOPE.

As one of the many Yale students working on the conference, I am excited and proud to share information about it with you.  The conference will offer an amazing opportunity to think and learn about the most important healthcare issues with key leaders from multiple sectors.  I know that it will be great experience.  I hope you can join us.

The conference offers:

• Diverse Industry Representation - The conference attracts people from all parts of healthcare, including insurance, providers, pharmaceutical and biotechnology, and government.  Cross-collaboration is especially important in healthcare and this conference provides the opportunity to learn from and network with people from a diverse set of backgrounds.  
• Discussion-Based Breakout Sessions - The conference hosts 16 breakout sessions that allow for expert-led discussions.  These sessions allow you to ask the questions on your mind to experts, including business executives, academics, and providers.
• Industry Thought Leaders – Hear industry thought leaders’ take on the changes happening in our healthcare system.  This is an opportunity for you to learn more from leading pundits on the new legislation. 

 For more information about the conference, and to register, please visit http://www.yalehealthcare.com/.

Hygeia Note:  On March 30th, Disruptive Women in Health Care launches the first of its monthly in-person breakfasts.  Among our speakers will be Stephanie Cohen.  Her post appears below.

By Stephanie Cohen.  This month’s health insurance nightmare: Dad is still paying for his daughter’s insurance — and no one is happy.

The situation: I received a call last week from a client whose daughter recently told him she hates her insurance “because it does not cover anything.” He phoned me to see if she had a real gripe, and if I could help him find another policy with better coverage for her.

The problem: It turned out that her policy had a $5000 deductible, which did not include coverage for dental or vision doctor visits. Since she has an entry-level position and not a lot of extra spending money, I told her she had a choice.

She could choose to pay more per month to lower her out-of-pocket expenses, but her monthly premiums would be higher. Since her father was paying her premium, and was happy to do so, I decided the best policy for her was one with a higher premium and lower expenses.

The solution: The decision to pay for an adult child’s health care is a personal one that each family must make, of course. The reality is that once a child turns an age selected on the policy by the plan administrator based on the rules of the state and the size of the employer, they are no longer considered a dependent.

Many times, the insurance company does not notify the parent or the plan administrator that the student has been dropped. The student typically finds out when filling a prescription or when receiving services. 

Keep in mind that it is the parents’ responsibility to notify the carrier that the student is or is not a full-time student and is eligible for coverage. The student is responsible for having a student certification form completed and signed by the bursars office proving they are in school fulltime with 12 plus credits.

If I were the Health Insurance Ambassadors: All students would have to prove they had coverage or they could not attend school.

Although with the recent health reform legislation there is now a new Federal mandate to allow children to be on their parents health plan until 26, it still may be less expensive to insure that child unto themselves rather than remain on the parents plan.  Obviously, the rates will be much lower for someone who is much younger.

The painful truth: Parents can analyze the cost of coverage through the school or an individual policy versus the cost of keeping the child on his/her plan. If the parent has other children on the plan, it rarely saves to pull one child off the plan.

 I encourage you to share your insurance nightmares with me.

By Santi Bhagat, MD, MPH.  Policymakers and insurance industry are battling over a key feature of health care reform.  As the president proclaims the bill will cover and protect all children with pre-existing conditions this year, the insurance industry is contending that the law reads differently.   

Congressional leaders are outraged that insurers are trying to wriggle out of their legal responsibility to insure new children who have pre-existing conditions. 

1. Insurers are interpreting bill language to mandate coverage of pre-existing conditions of children only if they are currently enrolled in plans, but not for new, uninsured child customers with pre-existing conditions. 
2.  The administration vows to fix this by having Health and Human Services (HHS) issue regulations next month to clarify the law’s intent to both provide access to insurance and a full range of benefits for all children with chronic conditions this year. 
3. Insurers plan to act on legislation language.  They will not say how they will respond to regulations and forecast that the courts will be the final arbiters.
4.  HHS spokesman and chairmen of Congressional health policy committees in the House of Representatives assert that the administration’s solution adequately addresses this problem.  
5. Citing experiences in other states, insurers are saying that covering children with chronic conditions now will lead to higher rates that may be unaffordable.  They believe that it is better to wait until 2014, when the risk can be spread since most Americans will have to be covered that year.
6. Regardless, insurers are free to charge what they want until 2014, when health status can no longer be used to calculate premiums. 

This is no small matter, for one in five American households, 8.8 million, has at least one child with a pre-existing condition.  Contrary to popular thought, most of these children are covered by private insurance.  The economic and job crises have impacted the ability of parents to maintain employer-based health insurance, forcing them to turn to the exorbitant individual market.  Children with individual coverage and who go without insurance for two months are at the greatest risk of being denied access.  From September 2010, the health care bill is supposed to prohibit insurers from denying individual and group coverage to children based on health status.

Health care reform does provide for a $5 billion dollar insurance pool of last resort that these families can turn to.   Hopefully, this mechanism will help families until this problem is straightened out.

Parents cannot wait to obtain coverage for their children who are in urgent of need of health care now.   Children are not simply little adults:  denying access and care to chronically ill children denies them the ability to grow, develop, play and learn.  As we watch the deliberations and wait for implementation of this piece of law, our children and families are losing precious time that can never be recovered.

By Robin Strongin. In recognition of the 30th anniversary of Women’s History Month, the Women’s Media Center (WMC) is profiling 30 extraordinary women making history.

Congratulations to our Disruptive Woman colleague Barbara Glickstein for being recognized as one of these extraordinary women.

Here’s what WMC’s Rebekah Spicuglia wrote about Barbara:

Barbara Glickstein: A Woman Making History
by Rebekah Spicuglia

Progressive Women’s Voices alumna Barbara Glickstein is a force to be reckoned with, not just because of her vast medical knowledge as a registered nurse, but because of how she uses that experience working tirelessly to promote her progressive and feminist values.

Barbara is unique not only in her expertise but her generosity with it. Last August she traveled to Kibera, Kenya – East Africa’s largest slum – and reported back in a WMC Exclusive ‘Imani’ For Rape Survivors: A Nurse’s Travels to Kenya with a perspective unique to someone with her feminist values and medical knowledge. “Sexual violence is widely considered to be the most underreported violent crime in Kenya,” she wrote. “The nurses shared a story of a woman they treated for rape who returned to the clinic to tell them that the police officer handed back her paper work telling her there was insufficient evidence this was a rape. A nurse who tried to follow-up at the police station was no more successful.” As a radio veteran – her WBAI show, Healthstyles, which provides information from front line health care workers and health advocates, has been running since 1986 – Barbara also provided essential support as Producer and Co-Host of WMC’s pilot radio show.

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Disruptive Women welcomes nationally recognized Intensive Care Specialist Dr. Brian Rosenfeld, as our March 2010 Man of the Month.

Dr. Rosenfeld is an Intensive Care Specialist (intensivist) who pioneered and developed the concept of remote intensive care unit management. He co-founded VISICU Inc. in 1998 with his partner Michael Breslow and served as its Executive Vice-President and Chief Medical Officer. The company had a successful IPO in 2006 and then was acquired by Royal Philips Electronics in 2008. He is currently responsible for devising the strategic direction of tele-health within Philips Patient Monitoring and Informatics.  Prior to founding VISICU, Dr. Rosenfeld was an Associate Professor of Anesthesiology and Critical Care Medicine, Medicine and Surgery at the Johns Hopkins University School of Medicine.  While at Hopkins, he was Director of two critical care units and received the Shannon Award from the National Institutes of Health.

Disruptive Women’s Robin Strongin recently had the opportunity to talk with Dr. Rosenfeld.  A few minutes into their conversation, says Robin, one thing becomes very clear:  Dr. Rosenfeld’s absolute passion for real-time, proactive, quality patient care.  In other words, telehealth—the technology behind Philips-VISICU.

As a cofounder of VISICU, What triggered the idea?

The idea was the easy part.  Developing a company was the hard part.  Before we started what was essentially a software company, I was an attending physician at Johns Hopkins Hospital.  Ironically, I almost had my privileges removed by my ICU colleagues because I initially refused to use the new EMR (electronic medical record) that had just been installed in the surgical ICU.  In the end, though, I recognized the power of information technology as it relates to patient care, high quality patient care.

My epiphany came as I realized that the current trajectory of baby boomers, and their need for ICU level care, was quickly overwhelming an already tenuous system.  ICUs account for 50% of all hospital deaths and approximately 30% of hospital costs; and many of them do not even have an intensivist involved in care delivery. There simply weren’t enough intensivists to meet the needs of this growing demographic group.

But there was a solution:  by utilizing technology and redesigned workflow to leverage the knowledge of intensivists in a way that reached exponentially greater numbers of patients.  By installing two-way audio/video connections and providing the appropriate information technology necessary to remotely monitor and intervene on patients, these highly trained physicians and critical care nurses could be on hand to provide care to many more patients in multiple sites across any geography. Virtually. Approximately 10% of all adult ICU beds in the United States are now monitored and managed with this technology.

What are the benefits of remote monitoring as you see them?

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By Robin Strongin.  Congratulations to our colleague, Sharon Terry!

Sharon was recently announced as an Ashoka Fellow for improving health outcomes for patients who have genetic diseases by aligning incentives and structures so that they facilitate, rather than obstruct, the continuum of research, drug development, treatment, advocacy, and support.

Ashoka is the largest association of leading social entrepreneurs in the world that strives to enable the world’s citizens to think and act as changemakers. Working in over 60 countries around the globe in every area of human need, Ashoka Fellows demonstrate an unrivaled commitment to bold new ideas through a combination of compassion, creativity and collaboration. Fellowship is a distinguished lifelong position attained only after a rigorous selection process.

You can share Sharon’s Ashoka journey by following her on Twitter at @sharonfterry.  She will also be blogging about her Ashoka experiences on Disruptive Women.

By Robin Strongin.  What a night…several decades in the  making as many Representatives kept reminding us. 

Why was last night different than all other nights? 

Perhaps because for the first time there was a WOMAN Speaker of the House.  Perhaps because we have a staggering number of Americans who have no or little access to health insurance.  Perhaps it’s because the entire system(s) of care are so badly broken. 

In the final analysis, a constellation of reasons, personalities, political high jinx, and circumstances will be identified.  I can already imagine the big fat book deals professors, news commentators, journalists and  talking heads are dreaming about signing.

I hope Eric Redman is one of them. 

Don’t know Eric?  If you are a political junkie with a craving for all things health related you must read his 1973 classic The Dance of Legislation. 

Here’s how The University of Washington Press describes this little gem:

“The Dance of Legislation has long been considered a classic description of the legislative process. In it, Eric Redman draws on his two years as a member of Senator Warren Magnuson’s staff to trace the drafting and passing of a piece of legislation – S.4106, the National Health Service Bill – with all the maneuvers, plots, counterplots, frustrations, triumphs, and sheer work and dedication involved. He provides a vivid picture of the bureaucratic infighting, political prerogatives, and Congressional courtesies necessary to make something happen on Capitol Hill. In a Postscript to the 2000 edition, Redman reflects on how that process has, and has not, changed in the thirty years since the book was first published.”

I wonder what Eric would have to say now, in 2010, on the eve of passage of Health Reform? 

Why do you think we got this far?

The big day is almost here… The House is voting on the health care reform bill. President Obama has been calling undecideds like Rep. Jason Altmire — and about 57,000 (of the 59,000) nuns in the country defied the bishops — stood up to the man — and sent a letter supporting the bill — calling it “the real pro-life choice” because it lets pregnant moms get prenatal care. (Talk about Disruptive Women!)

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By Ruth Lubic. The release this week of Amnesty International’s new report, Deadly Delivery: The Maternal Health Care Crisis in the USA,  highlights the poor outcomes of African American women in particular. 

When I set up The Developing Families Center in Washington DC’s Ward 5, it was with the goal of addressing this very issue, particularly from the point of view of infant mortality.

At a rate of 12.22 per thousand live births, the District has the highest infant mortality of any of the states, with only Mississippi, at 10.74 also experiencing a double digit rate.

Washington D.C. leads the nation with the highest HIV/AIDS rates in the country– 3% of all adults and adolescents in the District live with HIV/AIDS (any percentage over 1% is considered a severe epidemic by the World Health Organization).

Officials have created an innovative partnership with a number of organizations and celebrities to distribute female condoms in HIV hotspots — and if you want to try them yourself, they’re now on sale at all the CVS’s in the District.

Disruptive Women’s Wendy Grossman spoke for a few minutes with Mary Ann Leeper, senior strategic advisor for the Female Health Company — about the D.C. initiative that started this week.

Q: Tell me about the DC initiative.
A: The initiative is just the coming together of the five different
groups: The MAC Foundation, the CDC, the Department of Health, the Female Health Company and CVS — coming together to bring the female condom to women in the D.C. area.

DC has the highest rate of HIV and STI’s in the country. The Department of Health has initiated a strong prevention outreach program. They’re also tying in the some of the key, community based organizations into the programs.

Q: The FDA approved the female condom almost 20 years ago, right?
A: Yes. The FDA approved the first female condom in 1993. The second
FC2 female condom — this is what it’s all about. It’s the reintroduction of the female condom into the U.S. It was approved about a year ago. Late last summer, we brought it into the US. To the cities that have the highest rates of STI’s and HIV — to work with them and reintroduce the female condom.

Q: What’s different about the new condom?
A: It’s a new material. We switched from a polyurethane material to a synthetic latex material called Nitrile that allowed us to move from a welding process — very intensive, expensive process — to a dipping process that’s very similar to what’s used for male condoms.
So it allows us to reduce the cost of the product to make it. It increases the donors and these NGOs they can better afford it.

Q: They’re crazy expensive, right?
A: They’re at least 30 percent less. The higher the order, the lower the cost.

Q: What about over the counter?
A: It’s only available right now in CVS in the District of Columbia.

Q: Isn’t the argument against condoms for dudes partly because it ruins the spontaneity? How long would it take to put that in? Just looking at it makes me think it could take me an hour?

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By Lynn Shapiro Snyder. There is nothing like a cold, hard statistic to hang your hat on. What better way is there to drive home your point in the courtroom, the conference room, the Senate chamber? But as much as numbers illuminate, they also obfuscate. Take, for instance, a recent New York Times article announcing that women outnumber men on our  nation’s payrolls. We have reached an historic milestone.

But before you break out the champagne, take a closer look. You actually do not need to search very hard. In fact, all it will take is a glance—one brief, passing glance into any of the thousands of corporate board rooms across America.

As of 2009, a wan 15.2 percent of Fortune 500 board members were women.  That means, for the average 10-person corporate board, there aren’t even two women in the room.  Suddenly the numbers aren’t looking so good. With women making up more than half of America’s workforce, how can there be so few women at the highest level where business decision-making gets done – the corporate boardroom.  The board recruits and retains the CEO and sets company policy.

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By Rebecca Camp. AUSTIN, TX– Today’s SXSH conference (South By Social Health) saw many successful, multi-disciplinary approaches to weaving together new media and health care. I was bothered, however, by a theme that’s becoming increasingly common in the health care conversation: patients treated as consumers.

When a company follows capitalistic principles, the goal is to increase value by offering better services at a lower price. The company strives to improve their bottom line by offering more value than their competitor, in an effort to put their competitor out of business. Offering good customer service complements this strategy. In industries other than health care, the result is a benefit to the consumer: quality products and service at a lower price. Southwest Airlines, for example, employs a very effective social media presence. They respond to complaints tweeted by customers, which is has garnered the company praise in addition to a loyal customer base. But does this consumer-centered strategy translate to health care?

Mayo Clinic is held as a model for value in health care, but attributing their success to “consumerism” is off-base. The new media strategies being presented by health care institutions at SXSH essentially boiled down to damage control by tending to disgruntled Twitterers, and analysis of the types of complaints being registered. Though claiming to be influenced by social media mavens at Mayo’s Rochester flagship, the strategy is misguided and far removed. Mayo Clinic works because of a philosophy of care that puts the needs of the patients first—which does not equate to reactionary PR moves on social media sites. Absolutely nothing about their strategy distinguished it from other industries—and in the context of health care, replicating the strategy of Southwest Air and its ilk borders on insulting. Mayo Clinic avoids the noisy Twittersphere when addressing something as important as patient care; when a complaint is registered, that’s what their specialized center for patient service is for. Their Sharing Mayo Clinic blog allows a community of patients, staff, and families to form, which anticipates service problems before they even occur. This is the absolute obligation of companies in charge of delivering health care to a society.

My issue is also a philosophical one.

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By Stephanie Cohen. This month’s health insurance nightmare: You believe the cost of your policy is too high and the benefits too low.

The situation: Sara E. was looking at new insurance options because she was concerned that her current policy cost too much and covered too little. A case in point was a recent eye exam. She had to pay for the appointment because she hadn’t yet met the $1000 deductible on her current policy.

The solution: It was clear that Sara did not understand the details of the policy she had purchased. It’s not unusual, but can prove problematic. In fact, we recommend that all of our customers make a list of the medical services they will likely need throughout the year. Before buying anything, we tell them to read the fine print on the policy and ask questions until they are certain they understand what they are paying for – and what will be an additional charge.

Here’s why: The fine print on an insurance policy can be complex. The bottom line is that if you purchase a policy with a high deductible, there will be no coverage until the deductible is paid in full. Deductibles apply to all coverage if you purchase an HSA (Health Savings Account) compatible plan – except for preventative services.

And realize this:

1. Deductibles can also apply to specific services such as lab work and hospitalization.

2. They also apply to services differently depending on whether they are in or out of network.

3. It’s important to know that deductibles may be cumulative or shared, or based on the calendar year or contract year. Know how it works for the policy you purchase.

4. If the policy is a Health Savings Account (HSA) versus a high-deductible plan, you will be able to write off the amount placed in the HSA account up to the maximum allowable by the government. The minimum deductible for HSA plans start at $1200 for a single and $2400 for a family.

5. Do note that there are many after-tax expenditures such as those that are included in the FSA Section 213 of the tax code, which can be written off that are not covered under an insurance policy, which is the advantage of an HSA.

If we were the Health Insurance Ambassadors

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